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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o fir. a <br /> CD APPLICATION FOR LAND USE PERMITS 3. < <br /> 0 <br /> _ r� c /� l�-�aD -C, w� <br /> OWNER ��/�c n// J GYEL I;re TELEPHONE <br /> m <br /> O <br /> ,�tt <br /> HOME ADDRESS S��Y �/���54/i�P.E � 1$7�/S �� SY/ r (/ <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 7-V A— �i�sr y�r �T of r�r� Su4Ty 6<v XT. <br /> LEGAL DESCRIPTION (see tax receipt) � <br /> N <br /> rn <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_�ADDITION o <br /> a <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: i� /e 14 6 <- lqy X `to& Er <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. nt i <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n N <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m �D <br /> NORTH (N). Co <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. `< <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N _ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. U3 o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P V <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PO S, RIVER U LES P CIFI/CJ�p��LLY PERMITTTEED. (, <br /> n <br /> 6. l� l I�// 5 Jr m � ' amxaaM W 9' z <br /> CWD <br /> 4V P = � : m <br /> I declare that this application (including any accompanying schedule) has beep mined b o the of my �j c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am h� wrelyl <br /> deta 1 and racy of o <br /> all information contained in this application(including any accompanying schedule)are th I r cognize : m :that this information I am providing will be relied upon by the County of Burnett Wisc t whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnthis information 1 am 'm <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other D <br /> authorized person to have access to the ab ve described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m <br /> SIGN HER <br /> (signatur of caner uil n tor) (date) <br /> ZONING ADMINISTRATOR � _ vi. . <br /> N N(T NNUI (T <br /> Ill CT O Ui (li O O <br /> OWNSHIP PERMITS MAY BE REQUIRED <br />